Estrogen-based hormonal therapy and the risk of thrombosis in COVID-19 patients
Corresponding Author
Corinne LaVasseur
Department of Internal Medicine, Oregon Health & Science University, Portland, Oregon, USA
Correspondence
Corinne LaVasseur, Division of Internal Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA.
Email: [email protected]
Search for more papers by this authorRick Mathews
Department of Biomedical Engineering, Oregon Health & Science University, Portland, Oregon, USA
Search for more papers by this authorJenny S. H. Wang
Department of Biomedical Engineering, Oregon Health & Science University, Portland, Oregon, USA
Search for more papers by this authorKylee Martens
Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon, USA
Search for more papers by this authorHannah Stowe McMurry
Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon, USA
Search for more papers by this authorShira Peress
Department of Internal Medicine, Oregon Health & Science University, Portland, Oregon, USA
Search for more papers by this authorJean Sabile
Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon, USA
Search for more papers by this authorThomas Kartika
Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon, USA
Search for more papers by this authorIleisa Oleson
Department of Internal Medicine, Oregon Health & Science University, Portland, Oregon, USA
Search for more papers by this authorJamie O. Lo
Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon, USA
Search for more papers by this authorThomas G. DeLoughery
Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon, USA
Search for more papers by this authorOwen J. T. McCarty
Department of Biomedical Engineering, Oregon Health & Science University, Portland, Oregon, USA
Search for more papers by this authorJoseph J. Shatzel
Department of Internal Medicine, Oregon Health & Science University, Portland, Oregon, USA
Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon, USA
Search for more papers by this authorCorresponding Author
Corinne LaVasseur
Department of Internal Medicine, Oregon Health & Science University, Portland, Oregon, USA
Correspondence
Corinne LaVasseur, Division of Internal Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA.
Email: [email protected]
Search for more papers by this authorRick Mathews
Department of Biomedical Engineering, Oregon Health & Science University, Portland, Oregon, USA
Search for more papers by this authorJenny S. H. Wang
Department of Biomedical Engineering, Oregon Health & Science University, Portland, Oregon, USA
Search for more papers by this authorKylee Martens
Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon, USA
Search for more papers by this authorHannah Stowe McMurry
Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon, USA
Search for more papers by this authorShira Peress
Department of Internal Medicine, Oregon Health & Science University, Portland, Oregon, USA
Search for more papers by this authorJean Sabile
Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon, USA
Search for more papers by this authorThomas Kartika
Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon, USA
Search for more papers by this authorIleisa Oleson
Department of Internal Medicine, Oregon Health & Science University, Portland, Oregon, USA
Search for more papers by this authorJamie O. Lo
Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon, USA
Search for more papers by this authorThomas G. DeLoughery
Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon, USA
Search for more papers by this authorOwen J. T. McCarty
Department of Biomedical Engineering, Oregon Health & Science University, Portland, Oregon, USA
Search for more papers by this authorJoseph J. Shatzel
Department of Internal Medicine, Oregon Health & Science University, Portland, Oregon, USA
Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon, USA
Search for more papers by this author*Parts of this work were presented at the American Society of Hematology annual meeting, December 2022, New Orleans, LA, USA.
Abstract
Objective
Estrogen-containing contraceptives and hormone replacement therapy are used commonly, however, the risks of venous and arterial thrombosis imparted by such medications during COVID-19 infection or other similar viral infections remain undescribed.
Methods
To assess the risk of venous and arterial thrombosis in patients receiving oral estrogen-containing therapy (ECT) with COVID-19 as compared to those receiving non-estrogen-based hormonal therapy, we conducted a multicenter cohort study of 991 patients with confirmed COVID-19 infection, 466 receiving estrogen-containing hormonal therapy, and 525 receiving progestin-only or topical therapy.
Results
The use of estrogen-containing therapy was found to significantly increase the risk of venous thromboembolism (VTE) following COVID-19 diagnosis after controlling for age (HR 5.46 [95% CI 1.12–26.7, p = .036]). This risk was highest in patients over age 50, with 8.6% of patients receiving estrogen-containing therapy diagnosed with VTE compared to 0.9% of those receiving non-estrogen-based therapies (p = .026). The risk of arterial thrombosis was not significantly associated with oral estrogen use.
Conclusions
These results suggest that estrogen-containing therapy is associated with a significantly increased risk of VTE in COVID-19 patients, especially in older individuals. These findings may guide provider counseling and management of patients with COVID-19 on estrogen-containing therapy.
CONFLICT OF INTEREST STATEMENT
Joseph J. Shatzel reports receiving consulting fees from Aronora INC. The remaining authors report no conflicts of interests.
Open Research
DATA AVAILABILITY STATEMENT
The data that support the findings of this study are available from the corresponding author upon reasonable request.
Supporting Information
| Filename | Description |
|---|---|
| ejh14061-sup-0001-Supinfo.docxWord 2007 document , 15.7 MB | Figure S1. Participants assigned to the experimental (estrogen-containing therapy) group and control group. CHC; combined hormonal contraceptives. HRT, hormone replacement therapy; IUD; progesterone intrauterine device; Topical, topical estrogen. Figure S3. Multivariable Fine-Gray regression of A. venous thrombosis and B. arterial thrombosis in patients prescribed estrogen-containing therapy (ECT) adjusted for increasing age (each year). Figure S2. Cumulative incidence for A. venous and B. arterial thrombotic events in the estrogen containing therapy and control groups during COVID-19 infection. ECT, Estrogen-containing therapy. Table S1. ICD-10-CM codes. |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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